Kidney Week

Abstract: SA-PO482

Addressing Cognitive Impairment in Peritoneal Dialysis: A Systematic Review of Prevalence, Risk Factors, and Outcomes

Session Information

• Home Dialysis - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Aiumtrakul, Noppawit, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States

Noppawit Aiumtrakul, MD

• Thongprayoon, Charat, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States

Charat Thongprayoon, MD, FASN

• Yingchoncharoen, Pitchaporn, Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, United States

Pitchaporn Yingchoncharoen, MD

• Wannaphut, Chalothorn, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States

Chalothorn Wannaphut, MD

• Suppadungsuk, Supawadee, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, United States

Supawadee Suppadungsuk, MD

• Krisanapan, Pajaree, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, United States

Pajaree Krisanapan, MD

• Cheungpasitporn, Wisit, Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, United States

Wisit Cheungpasitporn, MD, FASN

Background

Cognitive impairment (CI) is a critical complication in peritoneal dialysis (PD), associated with increased hospitalization and mortality rates. Despite its significant impact, the prevalence and consequences of CI in PD patients are not well understood. This study aimed to determine the prevalence, risk factors, and outcomes of CI in PD.

Methods

We performed systematic reviews in OVID Medline, Embase, and Cochrane databases until January 2024 to identify cross-sectional and cohort studies on CI (identified by cognitive exams) in PD patients. Data on sample size, mean age, sex, prevalence of CI, risk factors, and outcomes were extracted. Pooled meta-analysis of prevalence was performed using a random-effects model. Risk factors for CI were ranked based on odds ratios (ORs) and other available metrics. Longitudinal studies were analyzed for objective data on CI-related outcomes. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42024526057).

Results

A total of 19 studies were identified, involving 2,882 PD patients. The weighted mean age was 55.02±9.42 years, and 52.38% of participants were male. The pooled prevalence of CI in PD patients was 47.7% (95% CI: 35.8-59.9%). Continuous Ambulatory PD (CAPD) (OR=7.7), depressive symptoms (OR=7.67), being female (OR=3.3), diabetes mellitus (DM) (OR=1.67), older age (OR=1.1), and fewer years of education (OR=0.78) were identified as significant risk factors for CI. Multiple linear regression showed that Automated PD (R² =0.64) and Serum Na (R²=0.56) were significantly associated with a decline in MoCA score. Cohort studies found that CI was significantly associated with higher rate of hospitalizations (HR=1.96) and peritonitis (HR=1.51), compared to those without CI. However, there was no difference in mortality in PD with CI, compared to non-CI groups (HR=0.58-1.18).

Conclusion

CI is common and appears to be underrecognized in PD patients. CAPD, depression, female, age, and DM are major risk factors for CI. CI in PD is associated with an increased rate of hospitalization and peritonitis. Further research is needed to establish standardized cognitive exams and guidelines for the timely management of risk factors of CI in PD patients.